LLQP Accident & Sickness · Component 4.2 · 10% of the exam
For an extended health claim (for example, a prescription), the claimant typically:
- Uses a drug card or submits receipts by the plan's deadline, with coordination of benefits details
- BFiles a claim through the courts, since prescription costs are a legal debt owed by the plan
- CObtains a physician's certification of disability, since the plan pays drug costs only during a disability
- DWaits 90 days after the purchase, since extended health claims are subject to a waiting period
Correct answer: A) Uses a drug card or submits receipts by the plan's deadline, with coordination of benefits details
Health claims are simple but have deadlines and COB rules. Late submission is a common reason for rejection.
Why the other options are wrong
- BHealth claims are routine.
- CDisability certification is not required for drugs.
- DNo waiting period applies.
Exam tip
EHC claims: drug card or receipts by the deadline; COB details.
Common mistake
Submitting receipts after the plan's claim deadline.
What this tests
CISRO competency component 4.2 — Provide customer service during the validity period of the coverage — which is weighted at 10% of the Accident & Sickness module. Written against the published curriculum.
More from component 4
- The agent's role in the claims process is to:
- A client with a non-cancellable DI policy stops paying premiums after a dispute with the insurer about a claim. The agent should warn that:
- When a client moves to another province, the agent should:
- A client asks to reduce the waiting period on his in-force disability policy. The agent should explain that the change:
- A client's disability policy lapsed six weeks ago for non-payment. The agent should:
- A client on claim asks whether she must keep paying premiums. The accurate answer depends on:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.